Subrecipient Legal Name:

Address:

EIN#:

DUNS:

Years in Business: Fiscal Year Start Date:Classification (only check one box below):

Public University/Institution of Higher Education

Private University

US Based For Profit Corporation (Publicly Held)

US Based For Profit Corporation (Privately Held)

US Based Small Business

Not for Profit Entity Public Entity/Govt Agency

Foreign Institution of Higher Education

Foreign Based For Profit Corporation (Publicly Held)

Foreign Based For Profit Corporation (Privately Held)

Foreign Based Small Business

Questionnaire Yes No N/A

Signature: Date

Subrecipeint Authorized Official Signature:

Does your entity adhere to Cost Accounting Standards Boards (CASB) regulations?

Are specific officials designated to approve payroll and other major transactions?

Subrecipient Questionnaire

Office of Sponsored Programs

If foreign, is the entity registered/licensed in the country in which it operates?

Do you have annual financial statements audited by an independent audit firm? If yes, please attach a copy of the statement for most recent year.Do you have a formal effort reporting policy and procedures to manage after-the-fact effort reporting?Does your entity maintain an inventory for government property that identifies data such as vendor, purchase date, cost, description, serial number, and disposition?

Is your organization required to comply with OMB Uniform Guidance regulations?

Does your entity have written accounting policies and procedures for procurement, payroll, inventory, vendor payments, cash management, and contract administration?Does your entity have a specified individual/officer who is the custodian of financial records? If yes, please list here: Are purchasing and payment functions separate?

Does your entity have a federally negotiated Facilities & Administraton Rate? If yes, attach a copy of rate agreement.

Title:

Subrecipient Legal Name:

Yes No

1.

Page 2

Subrecipient Questionnaire

5.

2.

3.

4.

Name of Highly Compensated Officers

The names and total compensation of the five most highly compensated officers of the entity(ies) must be listed if:

(i) the entity in the preceding fiscal year received— (I) 80 percent or more of its annual gross revenues in Federal awards (federal contracts (and subcontracts), loans, grants (and subgrants) and cooperative agreements); AND (II) $25,000,000 or more in annual gross revenues from Federal awards; and

(ii) the public does not have access to information about the compensation of the senior executives of the entity through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986.

Salary

Is reporting of executive compensation required (see explanation below)?

UAB Officer Signature:_________________________________ Date:_________________________________

UAB Official Use OnlyOSP Determination:

Subrecipient/Consortium

Vendor/Contractor

UAB Official Use OnlyOSP Determination:

___________________________________________________________________________________________________